Blood Pressure Management For CNAs

Transcription

1 Blood Pressure Management For CNAs This course has been awarded one (1.0) contact hour. This course expires on April 30, 2017 Copyright 2008 by RN.com. All Rights Reserved. Reproduction and distribution of these materials are prohibited without the express written authorization of RN.com. First Published: January 15, 2009 Revised January 15, 2012

2 Disclaimer RN.com strives to keep its content fair and unbiased. The author(s), planning committee, and reviewers have no conflicts of interest in relation to this course. Conflict of Interest is defined as circumstances a conflict of interest that an individual may have, which could possibly affect Education content about products or services of a commercial interest with which he/she has a financial relationship. There is no commercial support being used for this course. Participants are advised that the accredited status of RN.com does not imply endorsement by the provider or ANCC of any commercial products mentioned in this course. There is no "off label" usage of drugs or products discussed in this course. You may find that both generic and trade names are used in courses produced by RN.com. The use of trade names does not indicate any preference of one trade named agent or company over another. Trade names are provided to enhance recognition of agents described in the course. Note: All dosages given are for adults unless otherwise stated. The information on medications contained in this course is not meant to be prescriptive or all-encompassing. You are encouraged to consult with physicians and pharmacists about all medication issues for your patients. Acknowledgements RN.com acknowledges the valuable contributions of...national Institute of Health, National Heart Lung and Blood Institute. "The Guide To Lowering High Blood Pressure" is a tool intended for people who are interested in learning more about preventing and controlling high blood pressure. Based on National Heart, Lung, and Blood Institute clinical guidelines and research studies, it provides up-to-date practical information on high blood pressure....nadine Salmon, RN, BSN, Course Coordinator. She is a South African trained RN with work experience in South Africa, the United Kingdom and the United States. She is also trained as a midwife, and has a background in Labor & Delivery & Postpartum nursing. Nadine is a Board Certified Lactation Consultant and has also worked in Medical Surgical Nursing and Home Health. She is also currently pursuing a Masters degree in Nursing. As the Clinical Content Specialist for RN.com, Nadine is responsible for creating and updating course content to current standards. Purpose and Objectives The purpose of Blood Pressure Management for CNA's is to inform CNA's of the causes of high blood pressure and the detrimental effects of hypertension on the body. High blood pressure detection, monitoring and treatment are also covered in this course.

3 After successful completion of this continuing education course, participants will be able to: 1. Identify normal blood pressure values. 2. Describe the causes of prehypertension and hypertension, and their effects on the body. 3. List risk factors for the development of heart disease and stroke. 4. Educate clients on high blood pressure prevention and lifestyle modifications. 5. Describe the medical management of hypertension. Introduction What Is Blood Pressure? Blood pressure is the force of blood against the walls of arteries. Blood pressure is recorded as two numbers: The systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes between beats). The measurement is written one above or before the other, with the systolic number on top and the diastolic number on the bottom. Normal blood pressure is less than 120 mmhg systolic and less than 80 mmhg diastolic. True or False? Systolic pressure is a measurement of blood pressure as the heart relaxes. False. Systolic pressure is a measurement of blood pressure as the heart beats / contracts. Blood Pressure Values in Adults Blood Pressure ranges in Adults (Ages 18 years and older): Category Blood Pressure Level (mmhg) Systolic Diastolic Normal Less than 120 and Less than 80 Prehypertension or High Blood Pressure Stage 1 Hypertension or Stage 2 Hypertension 160 or 100 Low Blood Pressure In Adults Within certain limits, the lower the blood pressure reading is, the better. There is no specific number at which day-to-day blood pressure is considered too low, as long as no symptoms of trouble are present (AHA, 2012). Most doctors consider chronically low blood pressure dangerous only if it causes noticeable signs and symptoms, such as: Dizziness or lightheadedness Nausea Fainting (called syncope) Cold, clammy, pale skin Dehydration and unusual thirst Rapid, shallow breathing Lack of concentration Fatigue Blurred vision Depression (ANA, 2012).

4 As long as no symptoms are present, low blood pressure is not a problem. However, if the patient's blood pressure is normally higher or if they are experiencing any of the symptoms listed above, the low pressure may have an underlying cause. Low blood pressure can occur with: Prolonged bed rest Pregnancy Decreases in blood volume Certain medications Heart problems (such as bradycardia or heart failure) Endocrine problems, such as an under-active thyroid (hypothyroidism) Severe infection (septic shock) Allergic reaction (anaphylaxis) (ANA, 2012). Nursing Alert! If your patient suddenly experiences a sudden drop in blood pressure, with dizziness, lightheadedness, blurred vision and/or fainting, the RN or healthcare provider should be notified immediately. If there are no symptoms of low blood pressure, there is no need for concern. High Blood Pressure and Hypertension Blood pressure is the force of blood against the walls of arteries. Blood pressure rises and falls during the day. When blood pressure stays elevated over time, it is called high blood pressure or hypertension. High blood pressure is dangerous because it makes the heart work too hard and contributes to atherosclerosis (hardening of the arteries). It increases the risk of heart disease and stroke, which are the first and third leading causes of death among Americans. High blood pressure also can result in other conditions, such as congestive heart failure, kidney disease, and blindness. A blood pressure level of 140/90 mmhg or higher is considered high. About two-thirds of people over age 65 have high blood pressure. A blood pressure reading greater than 120/80 mmhg but less than 139/89 mmhg, is classified as prehypertension (National Institute of Health, Jan 2012). This means that the risk of developing hypertension in the future is increased. High blood pressure increases the risk of developing heart disease and/or kidney disease, and for having a stroke. It is especially dangerous because it often has no warning signs or symptoms. Regardless of race, age, or gender, anyone can develop high blood pressure. It is estimated that one in every four American adults has high blood pressure. Once high blood pressure develops, it usually lasts a lifetime. True or False? A blood pressure reading of 140/90 is classified as prehypertension. False. Blood pressure must be greater than 120/80 but less than 139/89 to be classified as prehypertensive.

5 Incidence of Hypertension High blood pressure is common. About 65 million American adults have high blood pressure. It is very common in African Americans, who may get it earlier in life and more often than whites. Further, African Americans have a higher death rate from stroke and kidney disease than whites. Many Americans tend to develop high blood pressure as they get older, but this is not a part of healthy aging. Middle-aged Americans face a 90% chance of developing high blood pressure during their lives. Others at risk for developing high blood pressure are the overweight, those with a family history of high blood pressure, and those with prehypertension. True or False? Advancing age is a risk factor for developing high blood pressure. True. Many Americans tend to develop high blood pressure as they get older. Systolic Blood Pressure Systolic pressure is the force of blood in the arteries as the heart beats, and is the top number in a blood pressure reading. High blood pressure is 140 and higher for systolic pressure. Diastolic pressure does not need to be high for you to have high blood pressure. When systolic pressure is elevated without an increase in diastolic pressure, the condition is called "Isolated Systolic Hypertension," or ISH. About 65 percent of hypertensives over age 60 have ISH, but do not have any symptoms. If left uncontrolled, high systolic pressure can lead to stroke, heart attack, congestive heart failure, kidney damage, blindness, or other conditions. While it cannot be cured once it has developed, ISH can be controlled with lifestyle changes and / or medication. Clinical studies have proven that treating a high systolic pressure saves lives, greatly reduces illness, and improves the quality of life. Yet, most Americans do not have their high systolic pressure under control. A diagnosis of ISH should only be made when the systolic blood pressure reading is consistently high on several different occasions (ICSI, 2011). True or False? A diagnosis of ISH should only be made when the systolic blood pressure reading is consistently high on several different occassions. True. Diastolic Blood Pressure Diastolic pressure is the force of blood in the arteries as the heart relaxes between beats. It's shown as the bottom number in a blood pressure reading. The diastolic blood pressure has been and remains, especially for younger people, an important hypertension number. The higher the diastolic blood pressure the greater the risk for heart attacks, strokes and kidney failure.

6 As people become older, the diastolic pressure will begin to decrease and the systolic blood pressure begins to rise and becomes more important. A rise in systolic blood pressure will also increase the chance for heart attacks, strokes, and kidney failure. Physicians use both the systolic and the diastolic blood pressure to determine blood pressure category and appropriate prevention and treatment activities. True or False? The Diastolic pressure is more significant in determining hypertension in the elderly than the systolic pressure. False. In the elderly, the systolic pressure is more important in determing hypertension and tends to increase with age. The diastolic pressure tends to decrease with age. Risk Factors for Hypertension High blood pressure is a risk factor for heart disease and stroke. There are other risk factors for heart disease and stroke, most of which can be modified. The more risk factors there are, the greater the chances of developing disease. Heart disease and stroke risk factors that can be controlled are: High Blood Pressure / Hypertension Diabetes High Cholesterol Obesity and physical inactivity Tobacco Use / Smoking Risk factors beyond individual control are: Age (55 years and older for men and 65 years or older for women) Family history of early heart disease or family history of stroke Causes of High Blood Pressure The causes of high blood pressure vary. Causes may include narrowing of the arteries, a greater than normal volume of blood, or the heart beating faster or more forcefully than it should. Any of these conditions will cause increased pressure against the artery walls. High blood pressure might also be caused by another medical problem. Most of the time, the cause is not known. Although high blood pressure usually cannot be cured, in most cases it can be prevented and controlled. Detection of High Blood Pressure Routine blood pressure assessments are the best method of detecting elevated blood pressure, and should be performed regularly. Most doctors will diagnose a person with high blood pressure on the basis of two or more readings, taken on several occasions. A consistent blood pressure reading of 140/90 mmhg or higher is considered high blood pressure. If you suspect hypertension, always get two readings, taken at least two minutes apart, and expect the physician to average the results.

7 Some people experience high blood pressure only when they visit the doctor's office. This condition is called "white-coat hypertension." If the doctor suspects this, the patient may be asked to monitor their blood pressure at home or asked to wear a device called an ambulatory blood pressure monitor. This device is usually worn for 24 hours and can take blood pressure every 30 minutes. Effects of High Blood Pressure on the Body Find out about the effect of high blood pressure on your body. Click on the underlined text to get a closer look at what high blood pressure does to these organs.

8 Preparation for Blood Pressure Assessments As a CNA, you will have the opportunity to educate and prepare patients for blood pressure assessments. The following tips are useful to provide to patients prior to the physical exam to prepare them for blood pressure monitoring: Don't drink coffee or smoke cigarettes 30 minutes before measuring blood pressure. Rest for at least five minutes prior to the test with the back supported and feet flat on the ground. The arm should be rested on a table at the level of the heart. Wear short sleeves so the arm is exposed. Go to the bathroom prior to the reading. A full bladder can change a blood pressure reading. Performing A Manual Blood Pressure Assessment Although blood pressure readings are usually performed with an automated electronic or digital device, CNA's should be proficient in performing a manual blood pressure assessment. Manual, or aneroid, equipment includes a cuff, an attached pump, a stethoscope and a gauge. When the equipment is prepared, make sure the patient is relaxed and comfortable. Begin by placing the blood pressure cuff on the bare upper arm one inch above the bend of the elbow. Wrap the cuff evenly and firmly around the patient's arm. The cuff should be tight enough so that you can only slip two fingertips under the top edge of the cuff. Make sure the patient's skin doesn't pinch when the cuff inflates. Once the cuff is on, place the disk of the stethoscope face down under the cuff, just to the inner side of the patient's upper arm, using your non-dominant hand. Next, place the stethoscope ear pieces in your ears, with the ear pieces facing forward, toward the tip of your nose. Rest the gauge in the open palm of your dominant hand, so that you can clearly see the numbers on the gauge. Then, squeeze the pump rapidly with your dominant hand until the gauge reads 30 points above the patient's usual systolic pressure, if available. Be sure to inflate the cuff rapidly. Stop squeezing. Turn the knob on the pump toward you (counterclockwise) to let the air out slowly. Let the pressure fall 2 millimeters (2 lines on the dial), per second while listening for heart sounds. Note the reading on the gauge when you first hear a heartbeat. This is the systolic pressure. Note when you no longer hear the beating sounds. This is the diastolic pressure. Release the pressure completely and remove the cuff. Record your numbers either by writing the information down or by entering the information into an electronic personal health record. (Mayo Clinic, 2012) Prevention of Hypertension CNAs may need to educate patients of the importance of maintaining a healthy lifestyle to minimize the risk of developing hypertension later in life.

9 Steps to take to adopt a healthy lifestyle include: Maintaining a healthy weight by following a healthy eating plan, that emphasizes fruits, vegetables, and low fat dairy foods, and choosing and preparing foods with less salt (sodium). Research has shown that following a healthy eating plan can both reduce the risk of developing high blood pressure and lower an already elevated blood pressure. As body weight increases, blood pressure rises. Increasing physical activity. The American Heart Association (AHA) recommends at least 30 minutes of moderate activity on most days of the week. Brisk walking, bicycling, and gardening are examples. Limiting alcoholic beverages / drinking in moderation. Excessive alcohol intake can increase blood pressure and harm the liver, brain, and heart. Alcoholic drinks should be limited to one drink a day for women; two drinks a day for men. Quitting smoking. Smoking injures blood vessel walls and speeds up the process of hardening of the arteries. This applies even to filtered cigarettes. Medical Management of Hypertension The treatment goal is blood pressure below 140/90 and lower. Adopting healthy lifestyle habits is an effective first step in both preventing and controlling high blood pressure. If lifestyle changes alone are not effective in controlling blood pressure, it may be necessary to add blood pressure medications. Diuretics / water pills: Act on the kidneys to flush excess water and sodium from the body. Example: Lasix. Beta-blockers: Reduce nerve impulses to the heart and blood vessels. This makes the heart beat slower and with less force. Blood pressure drops and the heart works less hard. Example: Atenelol. ACE inhibitors: Angiotensin converting enzyme (ACE) inhibitors prevent the formation of a hormone called angiotensin II, which normally causes blood vessels to narrow. The ACE inhibitors cause the vessels to relax and blood pressure goes down. Example: Captopril. Calcium channel blockers: (CCBs): Keep calcium from entering the muscle cells of the heart and blood vessels. This causes the blood vessels to relax and pressure goes down. Example: Diltiazem. Medical Management of Hypertension Nervous system inhibitors: Relax blood vessels by controlling nerve impulses. This causes the blood vessels to become wider and the blood pressure to go down. Example: Catapres. Vasodilators: Directly open blood vessels by relaxing the muscle in the vessel walls, causing the blood pressure to go down. Example: Apresoline. Fortunately, there are many different drugs available to treat high blood pressure. They work in various ways. Often, two or more drugs work better than one. Did You Know? Did you know that Mineral Supplements such as potassium can help lower blood pressure? Recent research has shown that potassium can lower blood pressure.

10 Conclusion Hypertension is widespread in our community today and places patients at increased risk for cardiovascular disease and stroke (CDC, 2012). As a healthcare professional, the CNA needs to have a good understanding of the risks, causes and effects of hypertension, in order to better educate the public. Promotion of healthy lifestyle behaviors may reduce the risk of developing high blood pressure and decrease the need for the use of costly medications to control blood pressure. References American Heart Association [AMA], 2009 & High Blood Pressure. Retrieved January 7, 2009 and updated January 15, 2012 from: American Society of Hypertension, Inc. Retrieved January 6, 2009 from Blood Pressure Medications by emedtv. Retrieved January 7, 2009 from: CDC [Centers for Disease Control & Prevention], Heart Disease and Stroke Prevention: Addressing the Nation's Leading Killers: At A Glance Retrieved January 17, 2012 from: Heart Disease and Stroke Prevention ICSI [Institute For Clinical Systems Improvement], Hypertension Diagnosis and Treatment. Retrieved Jan 15, 2012 from: Mayo Clinic (2012). How To Take A Manual Blood Pressure. Retrieved Jan 11, 2012 from: NHLBI [National Heart, Lung and Blood Institute], Your Guide To Lowering High Blood Pressure. Retrieved January 7, 2009 from At the time this course was constructed all URL's in the reference list were current and accessible. rn.com. is committed to providing healthcare professionals with the most up to date information available. Copyright 2008, AMN Healthcare, Inc. Please Read: This publication is intended solely for the use of healthcare professionals taking this course, for credit, from RN.com. It is designed to assist healthcare professionals, including nurses, in addressing many issues associated with healthcare. The guidance provided in this publication is general in nature, and is not designed to address any specific situation. This publication in no way absolves facilities of their responsibility for the appropriate orientation of healthcare professionals. Hospitals or other organizations using this publication as a part of their own orientation processes should review the contents of this publication to ensure accuracy and compliance before using this publication. Hospitals and facilities that use this publication agree to defend and indemnify, and shall hold RN.com, including its parent(s), subsidiaries, affiliates, officers/directors, and employees from liability resulting from the use of this publication. The contents of this publication may not be reproduced without written permission from RN.com.